The Impact of Multidisciplinary Care for Diabetic Foot in Reducing Major Amputation Rates

Abstract

Statistical calculation was performed using IBM SPSS 20.0 softwarepackage. Results -NIRS MEASUREMENT Change of rSO2 after crossclamping was plotted against time ( Figure 1). This graph showed that rSO2 falls rapidly on ipsilateral and contralateral sides as soon as the CCA was cross-clamped, and reached the lowest level after few seconds. The relative change in rSO2 on the operated side decreased more versus contralateral side after clamping. A significant decrease of rSO2 was seen soon after clamping on ipsilateral side. No siginificant changes in rSO2 were observed in the contralateral side at any moment of procedure. NIRS AND SP CORRELATION We plotted the change of rSO2 at 5 min after cross-clamping CCA, against stump pressure measured soon after CCA was cross-clamped. There was no correlation between NIRS and SP (Pearson R ¼ 0.74). ROC CURVE ANALYSIS ROC curve showed an area under the curve of 0.54 (95% CI 0.29-0.8) for rSO2 to indicate shunt requirement using SP <40 mmHg as the cutoff value. At a cut-off value of 32% decrease or more for the cerebrovascular SO2, a sensitivity and specificity of 100% was found. Lesser cut-off values resulted in a gradual decrease of specificity and sensitivity (Table 1). Conclusion -Near-infrared spectroscopy (NIRS) allows easy and continuous monitoring of cerebral ischaemia during carotid endarterectomy procedure (CEA). Despite all positive features, we showed that this monitoring method is not so suitable during CEA for selective shunting. It shows immediate oxygenational change, but it's not correlating with stump pressure (SP). NIRS shows high sensitivity and specificity only after cosiderably decrease of frontal lobe regional saturation (rSO2). References 1. Calligaro K, Dougherty M. Correlation of carotid artery stump pressure and neurologic changes during 474 carotid endarterectomies performed in awake patients. Journal of Vascular Surgery. 2005;42(4):684-689.4. Hans S, Jareunpoon O. Prospective evaluation of electroencephalography, carotid artery stump pressure, and neurologic changes during 314 consecutive carotid endarterectomies performed in awake patients. Journal of Vascular Surgery. 2007;45(3):511-515. 2 AbuRahma A, Stone P, Hass S, Dean L, Habib J, Keiffer T et al. Prospective randomized trial of routine versus selective shunting in carotid endarterectomy based on stump pressure. Introduction -Diabetic foot is a common complication of diabetes which results in severe disturbances in patients' daily life. The aim of this study was to evaluate the impact of a multidisciplinary diabetic foot team (MDFT) establishment in Kaunas county, Lithuania (570,000 inhabitants, 4 % with diabetes) for diabetes-related lower extremity amputation structure. Methods -A retrospective analysis of lower-extremity amputations in Kaunas county was performed. Data was collected from 6 hospitals, including 1 university hospital (Hospital of Lithuanian University of Health Sciences Kaunas Clinics), where MDFT was established in 2014. Amputations were grouped into major (above the ankle) ...